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Investigating the Influence of Vitamin D Replacement Therapy on Magnesium Status

  • Elias E. Mazokopakis and Maria G. Papadomanolaki
Published/Copyright: December 1, 2018
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 118 Issue 12

To the Editor:

We read with great interest the article by Uwitonze and Razzaque1 about the important role of magnesium in vitamin D activation and function. It is known that several steps in vitamin D metabolism depend on magnesium as a cofactor,1,2 and taking large doses of a vitamin D supplement can induce severe depletion of magnesium.2

Aiming to determine the influence of vitamin D replacement therapy on magnesium status, we retrospectively analyzed data from previous studies,3,4 specifically looking at serum magnesium levels before and after 4 months of cholecalciferol supplementation among 186 patients with vitamin D deficiency and Hashimoto thyroiditis (HT) (173 women and 13 men; mean [SD] age, 37.3 [5.6] years). A 25-hydroxyvitamin D (25[OH]D) level less than 10 ng/mL was considered as severe vitamin D deficiency; 10 to 19.9 ng/mL, moderate deficiency; 20 to 29.9 ng/mL, mild deficiency (or insufficiency); and 30 ng/mL or greater, sufficiency. The normal range for serum intact parathyroid hormone (PTH) and magnesium was 15 to 68 pg/mL and 1.7 to 2.7 mg/dL, respectively.

All 186 patients were euthyroid (with or without medication) and vitamin D deficient. All patients had a normal calcium level and normal estimated glomerular filtration rate. None of the patients had diabetes or alcoholism. Of the 186 patients, 15 (8.1%) had severe vitamin D deficiency; 109 (58.6%), moderate deficiency; 62 (33.3%), mild deficiency; and 182 (97.8%), elevated serum intact PTH levels. Cholecalciferol supplementation with target serum 25(OH)D levels of 40 ng/mL or greater resulted in 213% increase in mean (SD) serum 25(OH)D levels, from 14.6 (7.2) ng/mL to 45.7 (4.3) ng/mL (P<.001); a 45% decrease in serum intact PTH levels, from 102.5 (15.2) pg/mL to 56.3 (18.4) pg/mL (P<.001); and a 2.6% decrease in serum magnesium levels, from 1.92 (0.3) mg/dL to 1.87 (0.2) mg/dL (P=.059). After cholecalciferol supplementation, all patients remained normocalcemic and none had serum magnesium levels below 1.7 mg/dL or clinical signs of hypomagnesemia. The reduction in serum magnesium levels was greater among the 15 patients with severe vitamin D deficiency (−9.5%).

The results of investigation revealed that vitamin D deficiency is a common cause of secondary hyperparathyroidism in patients with HT.4 Although serum magnesium levels decreased after 4 months of cholecalciferol supplementation, hypomagnesemia or clinical manifestations of hypomagnesemia did not develop in any patient. However, a periodic assessment of serum magnesium levels among these patients is necessary because with continued cholecalciferol supplementation as maintenance therapy,5 further depletion of magnesium with possible clinical consequences could result. The depletion of magnesium is expected to be serious among patients who take vitamin D supplements and have coexisting conditions that increase the risk of magnesium deficiency, including insufficient dietary magnesium intake, hypoalbuminemia, chronic alcoholism, type 2 diabetes mellitus, gastrointestinal diseases (eg, celiac disease, chronic diarrhea, Crohn disease), and use of drugs (eg, insulin, loop and thiazide diuretics, aminoglycosides, proton pump inhibitors, and certain chemotherapies).6

Department of Internal Medicine, Naval Hospital of Crete, Chania, Crete, Greece
School of Production Engineering and Management, Technical University of Crete, Chania, Crete, Greece

References

1. Uwitonze AM , RazzaqueMS. Role of magnesium in vitamin D activation and function.J Am Osteopath Assoc.2018;118(3):181-189. doi:10.7556/jaoa.2018.037Search in Google Scholar PubMed

2. Reddy P , EdwardsLR. Magnesium supplementation in vitamin D deficiency.Am J Ther. Published online May 3, 2017. doi:10.1097/MJT.0000000000000538Search in Google Scholar PubMed

3. Mazokopakis EE , PapadomanolakiMG, TsekourasKC, EvangelopoulosAD, KotsirisDA, TzortzinisAA. Is vitamin D related to pathogenesis and treatment of Hashimoto's thyroiditis?Hell J Nucl Med.2015;18(3):222-227.Search in Google Scholar

4. Mazokopakis E , PapadomanolakiM, SkarakisSN, TsekourasK. Primary and secondary hyperparathyroidism among vitamin D deficient Hashimoto's thyroiditis patients and the need for a parathyroid scan [letter]. Hell J Nucl Med. 2017;20(3):258-259. doi:10.1967/s002449910613Search in Google Scholar PubMed

5. Pfotenhauer KM , ShubrookJH. Vitamin D deficiency, its role in health and disease, and current supplementation recommendations.J Am Osteopath Assoc.2017;117(5):301-305. doi:10.7556/jaoa.2017.055Search in Google Scholar PubMed

6. Martin KJ , GonzálezEA, SlatopolskyE. Clinical consequences and management of hypomagnesemia. J Am Soc Nephrol. 2009;20(11):2291-2295. doi:10.1681/ASN.2007111194Search in Google Scholar PubMed

Published Online: 2018-12-01
Published in Print: 2018-12-01

© 2018 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  1. OMT MINUTE
  2. An Osteopathic Approach to Stasis Dermatitis and Chronic Venous Insufficiency
  3. LETTERS TO THE EDITOR
  4. Investigating the Influence of Vitamin D Replacement Therapy on Magnesium Status
  5. Response
  6. HEALTH POLICY
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  8. ORIGINAL CONTRIBUTION
  9. Industry Payments in Cardiology: A Cross-sectional Analysis of Open Payments Data
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https://doi.org/10.7556/jaoa.2018.167
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. OMT MINUTE
  2. An Osteopathic Approach to Stasis Dermatitis and Chronic Venous Insufficiency
  3. LETTERS TO THE EDITOR
  4. Investigating the Influence of Vitamin D Replacement Therapy on Magnesium Status
  5. Response
  6. HEALTH POLICY
  7. Guns and Older Adults: The Physician's Role
  8. ORIGINAL CONTRIBUTION
  9. Industry Payments in Cardiology: A Cross-sectional Analysis of Open Payments Data
  10. Utility of 4-Factor Prothrombin Complex Concentrate in Trauma and Acute-Care Surgical Patients
  11. BRIEF REPORT
  12. Adjuvant Lymphatic Osteopathic Manipulative Treatment in Patients With Lower-Extremity Ulcers: Effects on Wound Healing and Edema
  13. JAOA/AACOM MEDICAL EDUCATION
  14. Moving Toward Milestone-Based Assessment in Osteopathic Manipulative Medicine
  15. Exodus From the Classroom: Student Perceptions, Lecture Capture Technology, and the Inception of On-Demand Preclinical Medical Education
  16. CASE REPORT
  17. Scalp Sarcoidosis Presenting as Cicatricial Alopecia
  18. Spontaneous Infrarenal Aortic Dissection in an Athlete Managed Emergently With Endovascular Stent Grafts, Occluders, and Femoral-Femoral Artery Bypass
  19. CLINICAL IMAGES
  20. Bullous Diabeticorum
  21. Posterior Cortical Atrophy
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